People are asking...Are more workers covered by fee-for-service plans or HMOs?
Answer: According to data from the 2008 BLS survey of employee benefits, 78 percent of all private industry workers covered by an employer medical care plan were enrolled in a fee-for-service plan. Only 4 percent of workers were traditional plans that allowed the participant the choice of any provider without affecting reimbursement. Preferred Provider Organizations or PPOs, were available to 58 percent of all private industry workers. Preferred-provider plans allow enrollees to obtain services from any provider, but offer incentives if services are obtained from selected providers. Exclusive provider organizations (EPOs), covered 5 percent of private industry workers. These plans obligate employees to use their providers exclusively to receive coverage. Finally, 15 percent of workers were enrolled in point-of-service(POS) plans. POS plans combine features of PPOs and traditional HMOs. Enrollees receive more generous benefits for services within the network and less generous benefits for care received outside the network or for self-referrals .
About 22 percent of workers were covered in Health Maintenance Organizations (HMO) plans, which provide comprehensive medical services on a prepaid basis. Eighteen percent of workers were in traditional HMOs that provide no benefits outside the network. Open access plans were available to 4 percent of workers. These plans allow enrollees to receive services outside the network, but at higher costs in the form of higher deductibles , copayments, or coinsurance.
For more information, see the latest benefit publication, found at www.bls.gov/ncs/#publications. Definitions of health care benefits terms may be found at www.bls.gov/ncs/ebs/detailedprovisions/2008/glossary_2008_2009.htm.
Last Modified Date: September 29, 2009